chapter 9 mechanisms and characteristics of sports trauma
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Chapter 9: Mechanisms and Characteristics of Sports Trauma. What is trauma? A physical injury or wound sustained in sport and produced by external or internal force. Tissues have relative abilities to resist a particular load. If the tissue is stronger, what will happen?

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slide2
What is trauma?

A physical injury or wound sustained in sport and produced by external or internal force.

slide3
Tissues have relative abilities to resist a particular load. If the tissue is stronger, what will happen?

The greater magnitude of load it can withstand.

slide4
List and define the five type of tissue stresses:
  • Tension
    • force that pulls or stretches tissue
  • Stretching
    • stretching beyond the yield point leads to rupturing of soft tissue or fracturing of a bone
  • Compression
    • a force that, with enough energy, crushes tissue
  • Shearing
    • a force that moves across the parallel organization of the tissue
  • Bending
    • force on a horizontal beam or bone that places stresses within the structure, causing it to bend or strain
slide5
What are the two categories of soft (non-bony) tissue and give examples
  • non-contractile
    • skin, joint capsules, ligaments, fascia, cartilage, dura mater, nerve roots nerve roots
  • contractile
    • muscle, tendons, bony insertions
slide6
What is the skin (integument)?

External covering of the body

slide7
What does the skin represent?

The body’s largest organ

slide9
List the numerous mechanical forces that can adversely affect the skin’s integrity:
  • friction or rubbing
  • scraping
  • compression or pressure
  • tearing
  • cutting
  • Penetrating
slide10
How are skin wounds classified?

According to the mechanical force that causes them

slide12
a. friction blister

continuous rubbing over the surface of the skin causes a collection of fluid below or within the epidermal layer called a blister

slide13
b. abrasion

common conditions in which the skin is scraped against a rough surface. The epidermis and dermis are worn away, exposing numerous blood capillaries

slide14
c. skin bruise

when a blow compresses or crushes the skin surface and produces bleeding under the skin, the condition is defined as a bruise, or contusion

slide15
d. laceration

a wound in which the flesh has been irregularly torn

slide16
e. skin avulsion

skin that is torn by the same mechanism as a laceration to the extent that the tissue is completely ripped from its source is an avulsion injury

slide17
f. incision

a wound in which the skin has been sharply cut

slide18
g. puncture

penetrations of the skin by a sharp object

slide22
How does one receive a contusion?

Sudden traumatic blow to the body

slide24
What is typical in cases of severe contusions?
  • the athlete reports being struck by a hard blow
  • the blow causes pain and a transitory paralysis caused by pressure on and shock to the motor and sensory nerves
  • palpation often reveals a hard area, indurated because of internal hemorrhage
  • ecchymosis, or tissue discoloration, may take place
slide25
What is a strain?

A stretch, tear, or rip in the muscle or adjacent tissue such as the fascia or muscle tendon

slide26
How are strains most often produced?

Abnormal muscular contraction

slide27
What is the cause of abnormal muscular contraction?

It is fault in the reciprocal coordination of the agonist and antagonist muscles take place. The cause of this fault or uncoordination is a mystery. However, possible explanations are that it may be related to:

  • a mineral imbalance caused by profuse sweating
  • to fatigue metabolites collected in the muscle itself
  • to a strength imbalance between agonist and antagonist muscles.
slide28
What is a grade 1 (or 1st degree or 1°) strain?

Slight over-stretching to mild tearing (20%) of the muscle fibers. It is accompanied by local pain, which is increased by tension in the muscle, and a minor loss of strength. There is mild swelling, ecchymosis, and local tenderness.

slide29
What is a grade 2 (or 2nd degree or 2°) strain?

Moderate tearing (20% - 70%) of the muscle fibers. It is similar to a grade 1, but has moderate signs and symptoms (moderate loss of strength, moderate swelling, ecchymosis, and local tenderness).

slide30
What is a grade 3 (or 3rd degree or 3°) strain?

Has signs and symptoms that are severe (severe swelling, ecchymosis, and local tenderness) with a loss of muscle function and, commonly, a palpable defect in the muscle.

slide32
Because a tendon is usually double the strength of the muscle it serves, where do tears commonly occur?

At the muscle belly, musculotendinous junction, or bony attachment

slide33
What is a cramp?

A painful involuntary contraction of a skeletal muscle or muscle group.

slide34
Cramps have been attributed to what?

A lack of water or other electrolytes in relation to muscle fatigue.

slide35
What is a spasm?

A reflexive reaction caused by trauma of the musculoskeletal system

slide36
List and define the two types of spasms or cramps:
  • clonic – alternating involuntary muscular contraction and relaxation in quick succession
  • tonic – rigid muscle contraction that lasts a period of time.
slide39
How is exercise over-dosage reflected?
  • Muscle soreness
  • Decreased joint flexibility
  • General fatigue 24 hours after activity.
slide40
What are the four specific indicators of possible overexertion?
  • acute muscle soreness
  • delayed muscle soreness
  • muscle stiffness
  • muscle cramping
slide41
List and define the two types of muscle soreness:
  • Acute-onset muscle soreness – which accompanies fatigue. This muscle pain is transient and occurs during and immediately after exercise.
  • Delayed-onset muscle soreness (DOMS) – becomes most intense after 24 to 48 hours and then gradually subsides so that the muscle becomes symptom-free after 3 or 4 days. (This second type of pain is described as a syndrome of delayed muscle pain leading to increased muscle tension, swelling, stiffness, and resistance to stretch).
slide42
What are the possible causes for delayed-onset muscle soreness?
  • It may occur from very small tears in the muscle tissue, which seems to be more likely with eccentric or isometric contractions.
  • It may also occur because of disruption of the connective tissue that hold muscle tendon fibers together.
slide43
What is muscle stiffness?

Muscle stiffness does not produce pain. It occurs when a group of muscles have been worked for a long period of time. The fluids that collect in the muscles during and after exercise are absorbed into the bloodstream at a slow rate. As a result, the muscle becomes swollen, shorter, and thicker and therefore resists stretch.

slide44
What can be done to assist in reducing muscle stiffness?
  • Light exercise
  • Massage
  • Passive mobilization
slide45
What is muscle guarding?

Following injury, the muscle that surrounds the injured area contract, in effect, splint that area, thus minimizing pain by limiting movement. (Quite often this splinting is incorrectly referred to as a muscle spasm)

slide46
How do chronic injuries usually progress?

Slowly, over a long period of time.

slide48
How does an acute injury cause a chronic injury?

If the acute injury is managed improperly or that allows an athlete to return to activity before healing has completely occurred.

slide49
What is myositis/fasciitis?

Inflammation of the muscle tissue

slide50
What is tendonitis?

Inflammation of tendon-muscle attachments, tendons, or both

slide51
What is tenosynovitis?

Inflammation of the synovial sheath surrounding a tendon

slide52
What is atrophy?

The wasting away of muscle tissue

slide53
What may cause atrophy?
  • Immobilization of a body part
  • Inactivity
  • Loss of nerve stimulation
slide54
What is a muscle contracture?

An abnormal shortening of a muscle tissue in which there is a great deal of resistance to passive stretch

slide55
What do joints consists of?

Cartilage and fibrous connective tissue

slide56
What is a joint capsule?

Bones of a diarthrotic (freely movable) joint are held together by a cuff of fibrous tissue

slide57
What are ligaments?

Sheets or bundles of collagen fibers that form a connection between two bones

Attach bone to bone

slide58
Ligaments fall into what two categories?
  • Intrinsic – occurring within the articular capsule
  • Extrinsic – separate from the capsular thickening
slide59
What is articular cartilage and what does it do?

Connective tissue that provides firm and flexible support

slide60
What are the major acute injuries that happen to synovial joints?
  • Sprains
  • Subluxations
  • Dislocations
slide61
What is a sprain?

Stretching or total tearing of the stabilizing connective tissues (ligaments)

slide62
What is a grade 1 (or 1st degree or 1°) sprain?

Slight over-stretching to mild tearing (20%) of the ligament. It is characterized by some pain, minimum loss of function, mild point tenderness, little or no swelling, and no abnormal motion when tested.

slide63
What is a grade 2 (or 2nd degree or 2°) sprain?

Moderate tearing (20% - 70%) of the ligament. There is pain, moderate loss of function, swelling, and in some cases slight to moderate instability.

slide64
What is a grade 3 (or 3rd degree or 3°) sprain?

It is extremely painful, with major loss of function, severe instability, tenderness, and swelling.

slide65
What is a subluxation?

Partial dislocations in which an incomplete separation between two articulating bones occurs.

slide66
What is a dislocation (luxation)?

Total disunion of bone apposition between articulating surfaces

slide67
What are several factors that are important in recognizing and evaluating dislocations?
  • Loss of limb function
  • Deformity
  • Swelling
  • Point tenderness
slide69
What is osteochondrosis?

Degenerative changes in the ossification centers of the epiphysis of bones

slide70
What is traumatic arthritis?

With repeated microtrauma to the articular joint surfaces, the bone and synovium thicken, and pain, muscle spasm, and articular crepitus, or grating on movement occur.

slide71
What is a bursa?

A fluid-filled sac found at places at which friction might occur within body tissues.

slide72
What is bursitis?

Inflammation of bursa at sites of bony prominences between muscle and tendon.

slide73
What is capsulitis and synovitis?

Chronic inflammatory conditions of the joints.

slide74
What are the five basic functions of bone?
  • Body support
  • Organ protection
  • Movement
  • Calcium reservation
  • Formation of blood cells
slide75
What are the three classifications of bone trauma?
  • Periostitis
  • Acute fractures
  • Stress fractures
slide76
What is periostitis?

Inflammation of the periosteum (bone covering)

slide77
What is an acute bone fracture?

A partial or complete interruption in a bone’s continuity

slide78
What is a stress fracture?

Rhythmic muscle action performed over a period of time at a sub-threshold level causes the stress-bearing capacity of a bone to be exceeded

slide79
What are the typical causes of stress fractures in sports?
  • Coming back into competition too soon after an injury or illness
  • Going from one event to another without proper training in the second event
  • Starting initial training too quickly
  • Changing habits or the environment
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